Beyond Psychopharmacology for Bipolar Disorder: Psychotherapeutic Interventions for the Patient and Family

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THIS INTEGRATED PSYCHOTHERAPY case of a patient with bipolar disorder who has been seen by the same psychiatrist for 12 years illustrates issues beyond psychopharmacology, including psychoeducation, supportive psychotherapy, psychodynamic psychotherapy, intermittent family therapy, and involvement of community resources. The psychopharmacological management of bipolar disorder is crucial; however, it is only one of the many resources available to help the patient achieve optimal functioning. At least one study of 20 bipolar patients involved in family systems therapy shows improved outcome, with fewer relapses and hospitalizations, as well as the family having less hopelessness and helplessness with regard to the mentally ill family member.1 Other studies examining the role of psychoeducation show that relapse prevention training may lower the risk of relapse in those patients with mania.2 Another study examined an interpersonal social rhythm therapy in which those patients experienced a significant reduction in depressive symptoms.3 In addition, this case illustrates challenges to the therapeutic alliance, primarily managing family involvement of the adult patient, the crisis of suicidal intent, and the role of advocacy.